Red, and your heart starts to race. Red, and your palms sweat. Red, and the sounds around you blur together. Imagine becoming emotionally aroused or distressed at the sight of simple stimuli, like the colour red, without knowing why.

Because triggers like this can take the form of harmless, everyday stimuli, trauma survivors are often unaware of them and the distress they cause in their lives. And clinicians who practice without the benefit of a trauma-informed lens are less able to help clients make the connection.

To address this and other concerns, researchers Nancy Poole and Lorraine Greaves in conjunction with the Centre for Addiction and Mental Health (CAMH) in Toronto recently published Becoming Trauma Informed, a book focused on the need for service providers working in the substance abuse and mental health fields to practice using a trauma informed lens.

Becoming Trauma Informed provides insight into the experiences, effects, and complexity of treating individuals who have a history of trauma. Without a clear understanding of the effect traumatic experiences have on development, it is challenging for practitioners to make important connections in diagnosis and treatment.

The authors describe how someone who self-harms may be diagnosed with bipolar disorder, possibly insufficiently treated with only medication and behaviour management. But using a trauma informed lens, the practitioner would more likely identify the self-harming patient as using a coping mechanism common to trauma survivors, giving rise to trauma informed care.

Such care involves helping survivors recognize their emotions as reactions to trauma. And helping clients discover the connection between their traumatic experiences and their emotional reactions can reduce feelings of distress.

Throughout the text, the authors describe an array of treatment options, pointing to ways they can be put into practice; for example, motivational interviewing to provide guidance during sensitive conversations, cognitive behavioural therapy for trauma and psychosis, and body centred interventions to allow clients to make connections between the mind and body, an approach that has become increasingly popular in recent years.

Importantly, the authors emphasize that a single approach to trauma-informed care is unrealistic and insufficient. While all treatments should include sensitivity, compassion, and a trusting relationship between therapist and client, specific groups require unique approaches.

The authors devote chapters to specific groups, including men, women, parents and children involved with child welfare, those with developmental disabilities, and refugees. They outline different approaches necessary for trauma informed care in various contexts, such as when working in outpatient treatment settings, in the treatment of families, and when working with women on inpatient units, where treatment requires sensitivity to both the individual’s lived experiences and environment.

A unique and compelling feature of this book is the focus on reducing risk of re-traumatization, an often neglected topic. Responding to the need for trauma survivors to feel safe, the authors outline how trauma informed care minimizes the use of restraints and seclusion (practices that can be re-traumatizing), and they offer ways to reduce the risk of re-traumatization by placing trauma survivors in less threatening situations, where they are less likely to feel dominated. This may involve matching female clients to female therapists or support groups comprised of only females.

The numerous case studies help illustrate specific scenarios, challenges, and outcomes of trauma informed care and highlight the growing recognition of the link between substance abuse, mental illness and traumatic experiences.

While the text is theoretically grounded, the authors convey information in a way that is accessible to wider audiences. It provides critical information for those working in the field by underscoring the relationship between past experiences and current functioning.

Becoming Trauma Informed delivers a deeply informative look into the field of trauma therapy.

Picture if you will, flashing screens, loud noises, focused faces and a crowd gathered to watch high stakes games; games that end only when you run out of money.

This is not a casino. Those faces are staring at flashing computer screens in an arcade and the high stakes match is actually a video game.

Scenes like this make it possible to view video gaming as an addiction. Like a gambler endlessly playing slots, the video gamer can spend hours on the vice of choice.

Those who consider gaming as addictive highlight similarities between models of addiction and the behaviour of those who can’t seem to stop playing video games, despite the consequences

What does it mean to be addicted to a video game? Addiction used to be a term reserved for drug use defined by physical dependency, uncontrollable craving, and increased consumption due to tolerance. Advances in neuroscience show that these drugs tap into the reward system of the brain resulting in a large release of the neurotransmitter dopamine. This is a system normally activated when basic reinforcers are applied, like food or sex. Drugs just do it better.

Gaetano Di Chiara and Assunta Imperato, researchers at the Institute of Experimental Pharmacology and Toxicology at the University of Cagliani, Italy, found that drugs can cause a release of up to ten times the amount of dopamine normally found in the brain’s reward system. This has led to a shift in how addictions are viewed. Any physical substance or behaviour that can “hijack” this dopamine reward system may be viewed as addictive.

When can you be sure that the system has been hijacked? Steve Grant, chief clinical neuroscientist at the National Institute of Drug Abuse, says it happens when there “is continued engagement in self-destructive behaviour despite adverse consequences.”

Video games seem to hijack this reward system very efficiently. Certainly Nick Yee, author of the Daedelus Project, thinks so. He explains, “[Video Games] employ well-known behavioral conditioning principles from psychology that reinforce repetitive actions through an elaborate system of scheduled rewards. In effect, the game rewards players to perform increasingly tedious tasks and seduces the player to ‘play’ industriously.” Researchers in the UK found biological evidence that playing video games and achieving these rewards results in the release of dopamine.

This same release of the neurotransmitter occurs during activities considered healthy, such as exercise or work. Since dopamine release is not bad per se, it is not necessarily a problem that video games do the same thing.

In her book, Reality is Broken: Why Games Make Us Better and How They Can Change the World, Jane McGonigal writes, “A game is an opportunity to focus our energy, with relentless optimism, at something we’re good at (or getting better at) and enjoy. In other words, game-play is the direct emotional opposite of depression.” Playing games can be an easy way to relieve stress and get that satisfaction that comes with dopamine release.

But it is concerning when this search for the dopamine kick becomes preferable to real life, when playing video games replaces activities like socializing with friends and family, exercising, or sleep. Nutrition may begin to suffer as the gamer picks fast-food over proper meals. School-work and job performance suffer as gaming turns into an escape from life. It becomes troubling when video games are used as the main way of coping.

Psychologist Richard Wood says just that in his article Problems with the Concept of Video Game “Addiction”: Some Case Study Examples. “It seems that video games can be used as a means of escape…If people cannot deal with their problems, and choose instead to immerse themselves in a game, then surely their gaming behaviour is actually a symptom rather than the specific cause of their problem.”

Regardless, there are some unable to stop despite the consequences. In rare cases it has actually caused death, through neglect of a child or physical exhaustion. Excessive video game playing may represent a way of coping with underlying issues. But it becomes its own problem when the impulse to play just can’t be denied.

Psychiatrist Kimberly Young, Director of the Center for Internet Addiction Recovery argues that “[gaming addiction is] a clinical impulse control disorder, an addiction in the same sense as compulsive gambling.” Her centre is one of many that are now found in the United States, Canada, the United Kingdom, and China.

These clinics treat those with gaming problems using an addiction model. They use detox, 12-step programs, abstinence training, and other methods common to addiction centres.

Notably, many people play well within healthy limits, and engage in the activity for diverse reasons. Stress relief, a way to spend time online with friends, or the enjoyment of an interactive storyline are all common reasons for playing. Whatever the reason for starting, when you can’t stop you have a problem.

We are often critical of labels in mental health, for good reason; they can be misused. On the other hand, a label can sometimes be helpful. If we call it an addiction, then we recognize it as a problem worth solving.

“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children” – Mahatma Gandhi

Over 18 million children are currently living in regions affected by war. While most humanitarian aid groups focus on meeting the basic physical needs of these children, in the midst of armed conflict, cognitive, social and emotional development is often inhibited and overshadowed by regional chaos.

Exposed to violent, traumatic and stressful situations that threaten their sense of stability and well-being, children have few places to simply be children, where they can play, learn and socialize safely. And few resources are in place to help them heal from the psychological burdens of war.

As the need for rehabilitative and restorative measures gains greater recognition by the international community, a growing number of child rights advocates, organizations and researchers are stepping forward to understand the implementation of psychologically therapeutic programs for war-affected children. The challenge is in figuring out what is needed, what is available and what will work across a variety of cultures, contexts and settings.

Seeking to bring psychological care on a tight budget, academics and policy advisors have emphasized evidence-based programs. Theresa Betancourt, professor and director of the research program on children and global adversity at Harvard’s school of public health, and her colleagues are evaluating the effectiveness of child trauma programs based in countries such as Uganda, Sierra Leone, Chechnya, Gaza, Sudan, Kosovo, Bosnia and Croatia.

Individual therapeutic interventions such as trauma focused therapy and narrative exposure therapy have shown promise among children affected by war and are approved by UNICEF as preferred techniques.

Group interventions have been used to accommodate the psycho-social needs of a greater number of children. These include Interpersonal group therapy for depression, creative play, mother-child psycho-education and support, and torture group psychotherapy with cognitive behavioural techniques.

Some other psycho-social initiatives have focused on the creation of Child Friendly Spaces (CFS’s) and Temporary Learning Centers (TLC’s) within refugee camp settings or local communities. These provide a child-centered environment for play, basic education and socialization; and they identify children in psychological distress.

But some concerns have been noted. The focus on trauma can lead to community stigmatization. In addition, these therapies are hard to carry out on a large scale due to the high costs of employing highly-trained professionals. Individualized services are rare and reserved for severely distressed children, usually demobilized child soldiers.

Problems arise when trying to apply western definitions and measures of distress that are not necessarily applicable to other cultures and contexts. And in understanding any given child’s psychological functioning, it is important to factor in ongoing stressful events and the social dynamics that a war-affected child must deal with on a daily basis.

There has been a movement away from a traditional western “clinical treatment” model toward a more inclusive, holistic framework of “psycho-social intervention,” termed to reflect the complex interplay between a child’s psychological and social development.

More effective group interventions for children have tended to be those that involve a school setting, address everyday stressors, utilize a form of trauma/grief-focused psychotherapy or use mind-body relaxation and coping techniques such as meditation, biofeedback and guided imagery.

Still, universal, comprehensive, culturally-sensitive psychological services for war-affected children remain a long way off. For more information on mobile psycho-social and education programs for war-affected children, please check out The Freedom to Thrive Foundation. Email FreedomToThriveFoundation@gmail.com to find out how you can get involved.